title: Fever in liver transplant recipients: changing spectrum of etiologic agents.
abstract: Febrile episodes in liver transplants were prospectively evaluated. Fever was due to infections in 78% of the episodes (35 of 45) and due to noninfectious causes in 22% (10 of 45). The predominant sources of fever were bacterial infections (62%; 28 of 45) and viral infections (6%; 7 of 45), whereas rejection accounted for only 4% of the episodes (2 of 45). Forty percent of the infections were unaccompanied by fever; fungal infections were significantly less likely to be associated with fever than were viral or bacterial infections (P = .001). Eighty-six percent (6) of the 7 febrile viral infections were due to viruses other than cytomegalovirus, of which human herpesvirus-6 was the predominant pathogen (71%; 5 of 7). Eighty percent (four) of the five febrile episodes with leukopenia were due to human herpesvirus-6. Episodes of fever were most likely to occur within 12 weeks (58%) or 1 year (29%) after transplantation; 100% of the latter episodes were in patients with recurrent hepatitis due to hepatitis C virus, malignancy, or chronic hemodialysis. In conclusion, cytomegalovirus and rejection were no longer the predominant etiologies of fever in liver transplant recipients, and viruses other than cytomegalovirus (e.g., human herpesvirus-6) are emerging as a significant cause of febrile viral illnesses in these patients.
authors.affiliation: Veterans Affairs Medical Center, Pittsburgh, Pennsylvania 15240, USA.
authors.forename: F Y
authors.initials: FY
authors.lastname: Chang
authors.forename: N
authors.initials: N
authors.lastname: Singh
authors.forename: T
authors.initials: T
authors.lastname: Gayowski
authors.forename: M M
authors.initials: MM
authors.lastname: Wagener
authors.forename: I R
authors.initials: IR
authors.lastname: Marino
mesh_terms: D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000150:complications; D005334:Fever / Q000209:etiology*; D006084:Graft Rejection; D006566:Herpesviridae Infections / Q000150:complications; D015654:Herpesvirus 6, Human; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D013997:Time Factors